The Post-Vaccine Age

Learning Benefits

Last August pastor Terri Pearsons of Newark, TX, stepped up to the pulpit, tossed aside her planned sermon, and preached the gospel of God and measles to the hundreds of families who had gathered at the Eagle Mountain International Church. “The measles are unrighteous,” she proclaimed. A visitor who’d picked up the virus on a trip to Asia had passed it on to the people he’d come in contact with at the church and Sunday school. “There is a possibility you or your child has been exposed,” Pearsons warned. Then she announced that four vaccination clinics would be available to the congregation at the church and its daycare center.

Even though 220 adults and children got the measles, mumps, and rubella (MMR) vaccine the next day, it was too little too late. For Russell Jones, the chief epidemiologist for the county, the fact that some congregants of the church—which has over 1,500 members—had chosen not to immunize their kids against the measles, or any other childhood disease, over the years was at the root of the problem. Without the MMR vaccine, 90 percent of people exposed to the virus will come down with the illness.

The number of confirmed cases of measles in Newark and the surrounding county eventually reached 21, and nearly all traced back to the outbreak at the church. While 21 cases may not sound alarming, the public health threat to that Texan town and county added to what was already a bad year for the rest of the country. By the end of 2013, the Centers for Disease Control and Prevention (CDC) had confirmed 166 cases of measles in the U.S.–-nearly three times the usual number. Because the measles was virtually eradicated in this country in 2000, experts find this stat particularly dismaying. This year’s outbreaks in New York City and California may continue the trend.

“This is what we have all been afraid of,” says Siobhan Dolan, M.D., the medical advisor for the March of Dimes, which is spearheading the Word of Mom campaign to encourage immunizations. The year “2013 has shown us what can happen when parents make the decision not to immunize their children. They’re putting not just their children at risk but entire communities.”

While 90 percent of all kids get their shots as scheduled, according to the CDC, the reality is that parents in some parts of the country, many of whom are affluent and well educated, are refusing vaccinations or limiting the ones their children receive. That number has been rising since the late 1990s, when a now debunked British study suggested that the MMR vaccine triggered autism. Despite evidence that showed no link between the MMR shot and autism, fear—fueled by anti-vaccine online sites and celebs like Jenny McCarthy—only grew. And despite the pushback from doctors and other medical experts, many parents are willing to discount medical evidence, either for religious reasons or because they worry about side effects and the sheer number of shots given to their babies.

The result: For the past 10 years, there has been a rash of epidemics, almost always in places where the rate of immunization is lower than the national average, says Jane Seward, M.D., deputy director of the CDC’s Division of Viral Diseases. For example, since 2010, there have been two epidemics of chicken pox, one in Florida and one in Indiana. Last year, along with the measles, there were three dozen cases of mumps in New Jersey and 20,496 cases of pertussis (whooping cough). Pertussis, in particular, can be deadly, especially for babies who haven’t yet started the series of shots that protects them from the disease: In 2012, another record year for pertussis cases (more than 48,000), 20 people died—15 of them newborns—according to the CDC.

“The idea that children are dying in this country from preventable diseases is just shocking,” says Dr. Dolan. But that is precisely the price everyone is paying for the backlash created by the anti-vaccine movement. It’s putting not only babies at risk but also older kids and adults with chronic conditions, like cancer, that weaken their immune systems.

Even worse is the convergence of factors fueling this surge of epidemics. We spoke to doctors and other medical experts to find out what they are—and what you can do to protect your family.

A culture of mistrust
It’s easy to take vaccines for granted. But just two generations ago, childhood illnesses often turned deadly. For example, before the measles vaccine became available in 1963, 450 children died every year from complications of the disease. Until the early 1950s, a polio epidemic swept the nation every year, leaving thousands of kids paralyzed, disabled, or dead. Before pediatricians started vaccinating kids against chicken pox in the late 1990s, 11,000 people were hospitalized every year, and 100 died, according to the CDC.

Yet thanks to inoculations, “parents aren’t confronted with diseases every day like they used to be, so their threat isn’t as real,” says Dr. Seward. It’s also hard to get the facts when there is so much misinformation out there, adds Jennifer Shu, M.D., a pediatrician at the Children’s Medical Group in Atlanta and co-author of Heading Home With Your Newborn. “Unfortunately, the misinformation gets as much or more attention and airtime as the true information. Parents end up fearing the effects of the vaccine more than the disease,” she explains.

The decline in herd protection
Sometimes, unvaccinated children are protected from communicable disease—ironically, from the families around them who have been vaccinated. That’s what doctors mean by “herd immunity,” which occurs when the immunized group is large enough to break the chain of infection before it reaches those who are vulnerable.

However, herd immunity is a numbers game, says Dr. Shu. It takes only a handful of parents to throw the formula off: “If immunization rates drop below 90 percent, the entire community will begin to see the effects,” she explains.

That’s close to happening in some parts of the country. In 2011, the Associated Press (AP) did an analysis of the states with the highest number of parents opting out of the vaccines that kids need to enter kindergarten. In eight states—Alaska, Colorado, Minnesota, Vermont, Washington, Oregon, Michigan and Illinois—the number of unvaccinated kindergartners was 1 in 20. And in some rural counties in Washington, the number of parents claiming nonmedical exemptions from vaccines is approaching 20 percent. That may be one reason that Washington was particularly hard hit by pertussis in 2012. During that record-breaking year, around 2,500 cases were diagnosed, the highest since 1942, and a whopping 1,300 percent increase from the previous year.

Global (and mobile) pathogens
Even if everyone in your community is vaccinated, your family is still at risk if you bypass shots. That’s because diseases like polio, measles, and rubella are alive and well around the world, says Dr. Seward—and only a plane ride away.

Neal A. Halsey, M.D., the director of the Institute for Vaccine Safety at Johns Hopkins Bloomberg School of Public Health, in Baltimore, explains that most foreign countries, even in Europe, do not require children to be fully immunized before attending school. So their immunization rates are lower—making it easier for travelers to bring contagious viruses to the U.S.

And if you’re not vaccinated, just because you don’t travel abroad doesn’t mean your risk is lower. It took only one person to travel to Asia, pick up the measles virus, and then spread it to 21 people in Texas. In fact, of the 166 cases of measles reported in 2013, only 2 were from unknown causes, according to the CDC. The rest could all be traced to folks who’d contracted the virus overseas and then spread it to others once they came back home.

Surprisingly short-lived immunity
Before the 1940s, when the vaccine became available, pertussis was one of the deadliest diseases of childhood, with 9,000 kids dying each year, according to the CDC. There are still outbreaks, though, despite the high rate of vaccination (more than 90 percent), partly because the disease still occurs in cycles. In older kids and adults, whooping cough symptoms can mimic a bad cough and cold. Often those who have the disease don’t even know they have it. But that makes it all the more deadly for babies, especially newborns, who tend to catch it from unsuspecting family members.

In the past few years, the number of cases in older kids has been rising. Experts now think one reason may be that immunity to the vaccine wears off sooner than they expected it to. In the 1990s, doctors switched to a new vaccine, called DTaP (diphtheria, tetanus, and acellular pertussis), because the older vaccine sometimes caused side effects, including high fevers and seizures. Children get five doses of the DTaP vaccine between the ages of 2 months and 6 years; at 11 or 12 they’re given a booster shot (called Tdap) that provides additional protection.
Still, a study by the CDC and health departments in Oregon and Minnesota suggests that protection from the DTaP shot may drop off when a child is 7—as many as four years before kids are given the Tdap booster. Another study, published in Pediatrics, found that teenagers who got the DTaP vaccine when they were younger were nearly six times more likely than those who got the original vaccine to become infected with whooping cough during the 2010 and 2011 California outbreaks.

Doctors now think the first vaccine was more effective. But until researchers come up with a newer, longer-lasting vaccine, the CDC advises parents to stick with the current schedule of immunizations. Even if the DTaP shot’s immunity doesn’t have the staying power doctors once thought it had, kids who get the entire series are up to 25 times more likely to be protected against whooping cough.

The grown-up factor
Shots aren’t just for kids. Parents who never completed a full set of the MMR vaccine can pass the measles or mumps virus to their kids. And grown-ups need their own boosters, though very few get them. For example, only 13 percent of adults receive the Tdap booster, according to the CDC, and that’s serious—adults can pass on pertussis, especially to babies under 3 months. That’s why the CDC advises that pregnant women be given a Tdap booster with each pregnancy.

Felicia Dube, whose 7-week-old son, Carter, died of pertussis in 2010, was vigilant about being vaccinated, and she made sure her older son, Zachary, got his DTaP shots on schedule, too. “When Carter got sick, I remember thinking, ‘My grandmother had whooping cough. People don’t get whooping cough these days,’ ” the Lancaster, SC, mom says.

For 10 days she and her husband lived at the hospital, watching their baby’s tiny body heave every time he had a coughing fit. “Losing a child is not something you can put a Band-Aid on and get over,” she says. “I miss him every day.”

Your Kids—and Community
With 70 percent of pediatricians reporting that they encounter parents who resist vaccinations, according to a survey by the American Academy of Pediatrics (AAP), kids’ doctors must walk a fine line these days between respecting parents’ views while educating them about the high-stakes for kids who don’t get their shots.

That’s why the AAP is now urging doctors to take the time with parents to fully explain the risks of not immunizing their children. “Ultimately, it is a parent’s decision to make, but they need to be armed with good information,” says Dr. Seward of the CDC. If you are one of those parents on the fence, this is what you need to know:

If you want to postpone vaccines:
Some parents want to create their own immunization schedule, delaying the number of shots their babies have at one time because they fear that an infant’s weak immune system won’t be able to withstand the onslaught of four or five vaccines at once. But doctors say that while the immunization schedule isn’t perfect, there are years of research behind it—and the amount of virus or bacteria in a vaccine is minute. Doctors say getting such a tiny amount is far less traumatic for a baby than developing the disease.

If you have concerns, talk them out with the pediatrician, say experts. Your doctor may be willing to work with you on a schedule that makes you more comfortable and minimizes the risk of your baby contracting the disease, says Jennifer Shu, M.D. For example, if your baby needs four shots, the doctor can give two one day, then ask you to come back for the other two. “But it’s really important that you come back soon to complete the series.”
Remember, too, it’s never too late for you to change your mind. “Better some than none, and better late than never,” says Dr. Shu.

If there’s an outbreak and your child is unvaccinated:
Have her immunized as quickly as possible, says Dr. Halsey. For some diseases, like the measles, the vaccine can sometime prevent the illness or at least lessen its severity if it’s given shortly after your child’s been exposed to the virus.

If you still decide to skip it, it’s important to take your kids to a doctor as soon as you suspect symptoms. Unvaccinated kids can get sicker faster—and develop complications much more quickly—because they’ve built up no immunity, says Dr. Shu.